Search and selection criteria
This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, http://www.crd.york.ac.uk/PROSPERO) as CRD42019133045. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform this review13. The authors identified studies published in MEDLINE, EMBASE, LILACS, CENTRAL and CINAHL databases, up to August 2019, using the terms “(((budesonide OR ciclesonide OR mometasone OR beclomethasone OR flunisolide OR fluticasone OR triamcinolone) AND (prednisone OR prednisolone OR hydrocortisone OR methylprednisolone OR dexamethasone OR betamethasone) AND (asthma exacerbations OR acute asthma OR acute wheezing OR wheezing exacerbations)))”, filtered for children birth–18 yrs and clinical trials; language restrictions were not applied.
To be included, studies had to meet all of the following criteria: 1) children (preschoolers to adolescents) with asthma presenting with an acute asthma in the ED or hospitalized 2) randomized clinical trials (RCTs; parallel group or cross-over design) of any duration; 3) comparison of ICS (by nebulizer or MDI) plus SC (oral or parenteral) vs. placebo (or standard care)plus SC; and 4) a report of at least one of the following outcomes: primary outcomes: hospital admission (for ED studies) or hospital length of stay [LOS] (for hospitalized studies); and secondary outcomes: asthma clinical score, readmissions during the follow-up, ED-LOS, lung function, oxygen saturation (SpO2), heart and respiratory rates, additional SABA requirements, and drug-related adverse effects [AEs] or severe adverse events [SAEs]. An SAE was defined as any untoward medical occurrence that results in death, is life-threatening, requires inpatient hospitalization, or results in persistent or significant disability or incapacity14.
We excluded studies that only involved patients experiencing their first wheezing episode or bronchiolitis and patients with other chronic respiratory conditions (e.g. bronchopulmonary dysplasia, cystic fibrosis, primary ciliary dyskinesia, and post-infectious bronchiolitis obliterans) or congenital cardiopulmonary conditions.